Prevalence, frequency, and motivations for alkyl nitrite use among gay, bisexual and other men who have sex with men in Australia

doi:10.1016/j.drugpo.2019.102659

International Journal of Drug Policy

Volume 76, February 2020, 102659

https://doi.org/10.1016/j.drugpo.2019.102659 Get rights and content

Abstract

Background and aims

Gay, bisexual and other men who have sex with men (GBM) use alkyl nitrites ('poppers') at higher rates than other populations to functionally enhance sexual experiences. Their use has been associated with HIV sexual risk behaviours including receptive anal sex. We investigate the prevalence, frequency, and motivations for poppers use and their relationship with HIV risk. We also discuss the implications of the recent scheduling changes to poppers by the Australian Therapeutic Goods Administration.

Methods

Data were drawn from the Following Lives Undergoing Change (Flux) study, a prospective observational study of licit and illicit drug use among GBM. Between 2014 and 2018, 3273 GBM enrolled in the study. In 2018, 1745 GBM provided data relating to frequency of and motivations for poppers use and were included in this analysis.

Results

Median age was 33 years (IQR 25–46) and 801 GBM (45.9%) had used poppers in the previous six months (‘recent use’). Among these men, 195 (24.3%) had used them weekly or more frequently. Most recent users (77.4%) reported using poppers for a ‘buzz’ during sex or to facilitate receptive anal intercourse (60.8%). The majority (57.7%) of HIV-negative men reporting recent poppers use were concurrently taking HIV pre-exposure prophylaxis. Recent poppers use was independently associated with receptive anal intercourse with casual partners (aOR 1.71; 95%CI 1.35–2.16) and chemsex (aOR 4.32; 95%CI 3.15–5.94). Poppers use was not associated with anxiety, depression, or drug-related harms. Only 15.4% of current users indicated they would stop using poppers if they were criminalised; 65.0% said they would ‘find other ways’ to obtain them.

Conclusions

Poppers are commonly used by Australian GBM to functionally enhance sexual experiences, particularly to facilitate receptive anal intercourse. Few men experienced drug-related harms from poppers use. Regulatory changes must ensure potential harms from popper use are minimised without increasing barriers to access or perpetuating stigma.

Section snippets

Background

Alkyl nitrites are a group of chemical compounds which include amyl nitrite and other volatile liquids referred to as ‘poppers’ (Haverkos, Kopstein, Wilson & Drotman, 1994). The use of poppers has been commonly reported among gay, bisexual and other men who have sex with men (GBM) (Bourne, 2012). In Australia, approximately two-thirds of GBM report lifetime use of poppers (Jin et al., 2018), with at least one-third of GBM reporting use in the previous six months (Jin et al., 2018; Lea et al.,

Methods

The methods of the Following Lives Undergoing Change (Flux) study have been described elsewhere (Hammoud et al., 2017). Flux is an ongoing online prospective observational study of licit and illicit drug use among GBM in Australia. Study promotion occurred via online advertising through social media, including popular gay ‘dating’ sites and apps, and Facebook. Once enrolled, participants completed online surveys at virtual study visits at six-monthly intervals. Participants provided informed

Results

Among the 1745 men included in this analysis, the median age was 33 years (interquartile range (IQR) 25–46). The majority of participants (90.5%) identified as gay and 7.0% identified as bisexual, with 32.6% of participants indicating that most of their friends were gay men. Of the remaining 39 men who did not self-identify as gay or bisexual, all but five reported that they described themselves as at least ‘somewhat’ gay. Other sexual identities included queer, pansexual, and prefer not to

Discussion

In this sample, two-thirds of Australian GBM reported lifetime poppers use, including 45.9% who had used poppers in the previous six months. Although most men reported only occasional or intermittent use, about one in nine participants used poppers at least weekly. Poppers were primarily used to facilitate more comfortable receptive anal intercourse, but many men also used them to get a rush during sex or on the dancefloor. Given the high ongoing prevalence of poppers use among GBM, the

Conclusion

Poppers are commonly used by GBM to functionally enhance sex, particularly receptive anal intercourse, including during group sex. Few men experienced drug-related harms from poppers use and motivations to continue to use poppers remain high among GBM in Australia. Regulatory changes to the classification of poppers must ensure that potential harms from popper use are minimised without increasing barriers to access or perpetuating stigma.

Acknowledgement

The study team would like to thank all participants for their continued participation in the Flux Study. This study was funded by the Australian Research Council (ARC). ARC grant number: DP140102483. The Kirby Institute, the center for Social Research in Health, and the Australian Research center in Sex Health and Society receive funding from the Australian Government Department of Health. Lisa Maher is supported by a National Health and Medical Research Council Senior Research Fellowship.

Declaration of Competing Interest

The authors have no conflicts of interest to declare.

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Cette étude nationale sur le chemsex fournit des données précieuses et souligne la nécessité de sensibiliser le public, les professionnels de la santé et les décideurs politiques aux dangers associés au chemsex et à ses conséquences sur la santé physique et mentale des personnes concernées. Il serait nécessaire de revoir la législation en matière de conduite après avoir fait usage de stupéfiants afin d’inclure les nouvelles drogues de synthèse fréquemment utilisées dans le chemsex. Une approche holistique impliquant la collaboration entre les professionnels de la santé, les autorités sanitaires et la société civile semble essentielle pour faire face à ce défi de santé publique émergent.
Chemsex, a recent and complex phenomenon, is increasingly recognized as a public health issue. However, limited data exists on its prevalence and specific characteristics in France. This national survey aims to fill this gap by gathering knowledge on the prevalence of chemsex, the characteristics of individuals involved, the most commonly used substances, and their health effects through a collaboration involving multiple toxicology laboratories under the auspices of the French Society of Analytical Toxicology (SFTA).
A call for participation was issued by the SFTA to all French toxicology laboratories and society members to report cases of chemsex identified between 2018 and 2023. The data collection period lasted for one month, and collected information included gender, age, origin, context (intoxication, deaths, Drug facilitated sexual assault DFSA, addiction, driving under the influence of drugs DUID), identified substances, routes of administration, symptoms, and observed concentrations. The collected data were then analyzed using Microsoft Power BI Desktop software (v.2.118.828.0) for data visualization.
A total of 232 chemsex cases were reported by 19 laboratories from 14 regions in France. The cases predominantly involved males (n = 222). The age of individuals ranged from 14 to 66 years (median: 35, mean: 37). Ninety cases of intoxication were reported, with common symptoms such as coma, loss of consciousness, agitation, and tachycardia. Fifty deaths (15 % of cases) related to chemsex were recorded. The most frequently identified substances were cathinones, GHB, cocaine, MDMA, and erectile dysfunction drugs (sildenafil). The results highlight a significant increase in the number of chemsex cases over time, indicating the growing magnitude of this phenomenon. Additionally, an emergence of chemsex-related products in contexts such as chemical submission and driving under the influence was observed.
This national study on chemsex provides valuable data and emphasizes the need to raise awareness among the general public, healthcare professionals, and policymakers regarding the risks associated with chemsex and its impact on the physical and mental health of individuals involved. Furthermore, legislation concerning driving under the influence of drugs (DUID) should be revised to include the new synthetic drugs commonly used in chemsex. A holistic approach involving collaboration among healthcare professionals, authorities, and civil society seems essential to address this emerging public health challenge.
Chemsex in France: A national study through interlaboratory collaboration under the auspices of the French Society of Analytical Toxicology (SFTA)
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Le chemsex, phénomène récent et complexe, est de plus en plus reconnu comme un problème de santé publique. Cependant, les données françaises sur sa prévalence et ses caractéristiques spécifiques en France sont encore limitées. Cette enquête nationale vise à combler cette lacune en rassemblant des connaissances sur la prévalence du chemsex, les caractéristiques des personnes impliquées, les substances les plus couramment utilisées et leurs effets sur la santé, grâce à une collaboration impliquant plusieurs laboratoires de toxicologie à la demande de la Société française de toxicologie analytique (SFTA).
Un appel à participation a été lancé par la SFTA à tous les laboratoires français de toxicologie membres de la société afin de notifier les cas de chemsex identifiés entre 2018 et 2023. Les informations collectées comprenaient le sexe, l’âge, la provenance, le contexte (intoxication, décès, soumission chimique, addiction, contrôle routier), les symptômes, les substances identifiées, les voies d’administration, et les concentrations mesurées. Les données ont été ensuite analysées à l’aide du logiciel de Datavisualisation Microsoft Power BI Desktop (v.2.118.828.0).
Deux cent trente-deux cas de chemsex ont été notifiés par 19 laboratoires provenant de 14 régions de France. Les cas concernaient principalement des hommes (n = 222). L’âge des personnes variait de 14 à 66 ans (médiane : 35, moyenne : 37). Quatre-vingt-dix cas d’intoxications (39 %) ont été signalés, avec des symptômes courants tels que coma, perte de conscience, agitation et tachycardie. Cinquante décès (15 %) ont été recensés. De plus, 61 cas de troubles liés à l’usage de substances indiquant une pharmacodépendance, et 18 cas de rapports sexuels non consentis ont été rapportés. Cependant, seuls 2 cas ont été recensés concernant la conduite après usage de substances psychoactives. Les substances les plus fréquemment identifiées étaient les cathinones, le GHB, la cocaïne, la MDMA et les médicaments contre la dysfonction érectile (sildénafil). Les résultats mettent en évidence une augmentation significative du nombre de cas de chemsex au fil du temps, passant de 19 cas en 2018 à 71 en 2022, témoignant de l’ampleur croissante de ce phénomène.
Cette étude nationale sur le chemsex fournit des données précieuses et souligne la nécessité de sensibiliser le public, les professionnels de la santé et les décideurs politiques aux dangers associés au chemsex et à ses conséquences sur la santé physique et mentale des personnes concernées. Il serait nécessaire de revoir la législation en matière de conduite après avoir fait usage de stupéfiants afin d’inclure les nouvelles drogues de synthèse fréquemment utilisées dans le chemsex. Une approche holistique impliquant la collaboration entre les professionnels de la santé, les autorités sanitaires et la société civile semble essentielle pour faire face à ce défi de santé publique émergent.
Chemsex, a recent and complex phenomenon, is increasingly recognized as a public health issue. However, limited data exists on its prevalence and specific characteristics in France. This national survey aims to fill this gap by gathering knowledge on the prevalence of chemsex, the characteristics of individuals involved, the most commonly used substances, and their health effects through a collaboration involving multiple toxicology laboratories under the auspices of the French Society of Analytical Toxicology (SFTA).
A call for participation was issued by the SFTA to all French toxicology laboratories and society members to report cases of chemsex identified between 2018 and 2023. The data collection period lasted for one month, and collected information included gender, age, origin, context (intoxication, deaths, Drug facilitated sexual assault DFSA, addiction, driving under the influence of drugs DUID), identified substances, routes of administration, symptoms, and observed concentrations. The collected data were then analyzed using Microsoft Power BI Desktop software (v.2.118.828.0) for data visualization.
A total of 232 chemsex cases were reported by 19 laboratories from 14 regions in France. The cases predominantly involved males (n = 222). The age of individuals ranged from 14 to 66 years (median: 35, mean: 37). Ninety cases of intoxication were reported, with common symptoms such as coma, loss of consciousness, agitation, and tachycardia. Fifty deaths (15% of cases) related to chemsex were recorded. The most frequently identified substances were cathinones, GHB, cocaine, MDMA, and erectile dysfunction drugs (sildenafil). The results highlight a significant increase in the number of chemsex cases over time, indicating the growing magnitude of this phenomenon. Additionally, an emergence of chemsex-related products in contexts such as chemical submission and driving under the influence was observed.
This national study on chemsex provides valuable data and emphasizes the need to raise awareness among the general public, healthcare professionals, and policymakers regarding the risks associated with chemsex and its impact on the physical and mental health of individuals involved. Furthermore, legislation concerning driving under the influence of drugs (DUID) should be revised to include the new synthetic drugs commonly used in chemsex. A holistic approach involving collaboration among healthcare professionals, authorities, and civil society seems essential to address this emerging public health challenge.
Characterizing changes in drug use behaviour following supply shortages of 5-MeO-DIPT, alkyl nitrites and new psychoactive substances among men living with HIV in Japan
2023, International Journal of Drug Policy
Since 2005, Japan has incrementally banned a range of new psychoactive substances (NPS), including 5-MeO-DIPT (5MO; foxy) and alkyl nitrites (AN; rush, poppers) that have commonly been used among men who have sex with men (MSM). After the largest ban in 2014, these drugs were reported to have disappeared from the domestic market. Given that 5MO/AN/NPS use has been prevalent among men living with HIV in Japan, a population largely comprised of MSM, we sought to characterize changes in their drug use behavior following the supply shortages.
Using data from two waves of a nationwide survey of people living with HIV in Japan in 2013 and 2019–20 (n = 1042), we employed multivariable modified Poisson regression to identify correlates of self-reported reactions to the 5MO/AN/NPS shortages and changes in drug use behavior in 2019–20 vs. 2013.
Among 391 men (96.7% MSM) surveyed in 2019–20, following the supply shortages, 234 (59.8%) stopped using 5MO/AN/NPS, 52 (13.3%) retained access to the supply, and 117 (29.9%) used substitute drugs: most commonly, methamphetamine (60.7%). Individuals who used substitutes were more likely to report unprotected sex (adjusted relative risk [ARR]=1.67; 95% confidence interval [CI]: 1.13–2.47) as well as low (ARR=2.35; 95% CI: 1.46–3.79) and lower middle (vs. upper middle to high) socioeconomic status (ARR=1.55; 95% CI: 1.00–2.41). The prevalence of past-year methamphetamine use (ARR=1.93; 95% CI: 1.11–3.35) and self-reported uncontrollable drug use (ARR=1.62; 95% CI: 1.07–2.53) were significantly higher in 2019–20 compared to 2013.
Following the supply shortages, approximately one-fifth of our participants used methamphetamine as a substitute for 5MO/AN/NPS. Methamphetamine use and perceived uncontrollable drug use also appeared to have increased at the population level after the supply shortages. These findings suggest a potentially harmful substance displacement effect of the aggressive ban. Harm reduction interventions are needed in this population.
Neither legal nor illegal: Poppers as ‘acceptable’ chemsex drugs among men who have sex with men in the Philippines
2023, International Journal of Drug Policy
Our article provides the first qualitative inquiry into the use of alkyl nitrites or poppers in the Philippines. Drawing from thematic analysis of 13 semi-structured interviews, we illuminate the role of poppers in the lives of men who have sex with men (MSM) in the country, arguing that the popularity of these substances is embedded within multiple, occasionally conflicting sexual and chemical ideologies. More than their multifunctionality as drugs that fulfill many roles and are used in various sexual settings, it is their ideological acceptability that largely explains their popularity. In the contexts of the ongoing Philippine drug war and of Philippine society's long history of stigmatizing people who use drugs, poppers are widely regarded as biomedically, sociopolitically, and legally ‘harmless’ and ‘acceptable’, especially relative to other substances used for chemsex. In constructing poppers as chemsex drugs, we depart from definitions of chemsex established mainly by the Global North and provide a glimpse into how MSM who use poppers situate themselves in a particularly hostile sociopolitical milieu. We consider the implications of our findings against the country's drug paradigm, reflecting on the nature of poppers as substances located in the gray area of legality, and what they mean for sexuality, drug use, and the localized, cultural taboos of our time.
A policy analysis of how alkyl nitrites (poppers) became prescription-only in Aotearoa New Zealand
2023, International Journal of Drug Policy
Alkyl nitrites (‘poppers’) are a group of drugs that includes amyl nitrite, butyl nitrite, and isopropyl nitrite. Their use is prevalent among men who have sex with men (MSM), to enhance sexual comfort and pleasure. In Aotearoa New Zealand, all alkyl nitrites became prescription-only from March 2020. With alkyl nitrites no longer sold locally in stores, and no availability via pharmacies (even with a prescription), access has been significantly reduced. This decision was opposed by advocacy groups and people who use alkyl nitrites. This policy case study explores how this decision was made and impacts on MSM.
We use policy formation theory; both policy framing and Multiple Streams Framework, to analyse factors that contributed to this regulatory decision. Analysis of issue framing by policy coalitions was undertaken through review of documents including submissions and committee minutes.
Two policy coalitions emerged, which differed in their issue framing. The Medicines Classification Committee conveyed concerns about evidence limitations, and recommended reclassification. NGOs and people who use alkyl nitrites communicated that there was no evidence of harm from alkyl nitrite use in New Zealand, and thus, given that there was evidence of benefit, the status quo should be maintained and further regulatory responses were unnecessary. Pre-existing processes created a situation where alkyl nitrite scheduling came unexpectedly onto the New Zealand policy agenda, and set the issue onto a somewhat pre-determined pathway with limited policy choices available.
As a drug policy case study, it appears that reclassification was initiated due to a policy process that did not enable or support plausible alternatives. While the purpose of the reclassification was to improve safety, there was no evidence of harm prior to reclassification, and the reduction in access is likely to have increased harm for MSM.

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Research PaperPrevalence, frequency, and motivations for alkyl nitrite use among gay, bisexual and other men who have sex with men in Australia

Abstract

Background and aims

Methods

Results

Conclusions

Section snippets

Background

Methods

Results

Discussion

Conclusion

Acknowledgement

Declaration of Competing Interest

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Sexual risk, nitrite inhalant use, and lack of circumcision associated with HIV seroconversion in men who have sex with men in the United States

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Validation and internal consistency of patient health questionnaire-9 for major depression in Parkinson's disease

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Research Paper
Prevalence, frequency, and motivations for alkyl nitrite use among gay, bisexual and other men who have sex with men in Australia